Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (4): 309-319.doi: 10.24920/004060
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Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction
Jianing Cui, Yanan Zhao, Wei Wang, Tao Li*(
)
- Department of Radiology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Received:2022-01-14Accepted:2022-04-19Published:2022-12-31Online:2022-05-30 -
Contact:Tao Li E-mail:litaofeivip@163.com
Cite this article
Jianing Cui, Yanan Zhao, Wei Wang, Tao Li. Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction[J].Chinese Medical Sciences Journal, 2022, 37(4): 309-319.
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Figure 1.
Corresponding segments of left ventricular myocardium with LAD, LCX and RCA perfusion areas defined based on a myocardial 16-segment model recommendated by the American Heart Association (AHA). LAD: left anterior descending artery; LCX: left circumflex artery; RCA: right coronary artery."
Figure 1.
Figure 2.
Short axis late gadolinium enhancement images corresponding to LAD, RCA and LCX territories. (A-C) Representative case of anterior wall myocardial infarction [Fig. A showing infarct and remote myocardium, Fig. B showing infarct myocardium (white arrows) with microvascular obstruction (yellow arrow heads)]. (D-F) Representative case of inferior wall myocardial infarction. (G-I) Representative case of lateral wall myocardial infarction."
Figure 2.
Figure 3.
Example of strain analysis in a patient with accute myocardial infaraction. (A-C) Delineations of the endocardium and epicardium on diastole phase. (D-F) Bull’s eye maps for radial, circumferential, and longitudinal strain assessments, respectively. (G-I) Strain-time graphs for radial, circumferential, and longitudinal strain assessments, respectively."
Figure 3.
Figure 4.
Flowchart of patient enrollment. STEMI: ST-segment elevation myocardial infarction; CMR: cardiac magnetic resonance; PCI: percutaneous coronary intervention; MI: myocardial infarction; MRI: magnetic resonance imaging; AWMI: anterior wall myocardial infarction; NAWMI: nonanterior wall myocardial infarction."
Figure 4.
Table 1.
Baseline clinical characteristics of the patients with STEMI (n = 95)"
| Characteristic | Results |
|---|---|
| Age (yrs, mean ± SD) | 54.73 ± 10.74 |
| Sex [male, n (%)] | 83 (87.4) |
| Height [cm, median (IQR)] | 170 (168, 175) |
| Weight [kg, median (IQR)] | 76 (70, 85) |
| Body mass index (kg/m2, mean ± SD) | 1.91 ± 0.18 |
| Risk factors [n (%)] | |
| Smoking | 70 (73.7) |
| Family history of CAD | 9 (9.5) |
| Hypertension | 54 (56.8) |
| Diabetes mellitus | 17 (17.9) |
| Hypercholesterolemia | 28 (29.5) |
| Time interval CMR after PCI [d, mean ± SD] | 5.90 ± 2.75 |
| No. of vessels diseased [n (%)] | |
| 1 | 28 (29.5) |
| 2 | 38 (40.0) |
| 3 | 29 (30.5) |
| Infarct related artery [n (%)] | |
| LAD | 44 (46.3) |
| LCX | 9 (9.5) |
| RCA | 42 (44.2) |
Table 1.
Table 2.
CMR parameters of LV function and infarct characteristics in patients with STEMI stratified by infarct location"
| Items | AWMI (n = 44) | NAWMI (n = 51) | t/Z | P value |
|---|---|---|---|---|
| EDVI [ml/m2, median (IQR)] | 69.13 (62.25, 86.76) | 74.96 (61.61, 87.96) | -0.735 | 0.462 |
| ESVI [ml/m2, median (IQR)] | 37.44 (31.41, 50.64) | 35.28 (29.38, 46.64) | -0.623 | 0.533 |
| SVI [ml/m2, median (IQR)] | 35.86 (27.16, 43.12) | 41.33 (31.47, 46.60) | -1.638 | 0.101 |
| EF [%, median (IQR)] | 47.31 (41.17, 52.44) | 51.99 (37.48, 55.57) | -1.317 | 0.188 |
| CO [L/min, median (IQR)] | 5.02 (4.44, 5.90) | 5.29 (4.73, 6.37) | -1.482 | 0.138 |
| CI [L/min·m2, median (IQR)] | 2.72 (2.37, 3.30) | 2.77 (2.52, 3.40) | -1.015 | 0.310 |
| HR [beat/min, median (IQR)] | 71.10 (62.45, 80.95) | 65.50 (58.00, 75.40) | -1.549 | 0.121 |
| Myocardial volume [ml, median (IQR)] | 94.10 (15.50, 123.60) | 92.98 (75.27, 121.40) | -0.037 | 0.970 |
| Myocardial mass [g, median (IQR)] | 113.82 (26.88, 134.76) | 96.22 (19.12, 127.90) | -0.761 | 0.446 |
| Extent of enhanced mass (%LV, mean ± SD) | 27.47 ± 11.89 | 21.06 ± 12.08 | 3.928 | 0.008 |
| Total enhanced volume [ml, median (IQR)] | 25.37 (12.98, 38.33) | 15.25 (8.27, 27.92) | -1.918 | 0.055 |
| Total enhanced mass (g, mean ± SD) | 30.46 ± 18.11 | 24.07 ± 16.58 | 3.784 | 0.056 |
| MVO volume [ml, median (IQR)] | 2.48 (1.55, 5.35) | 1.72 (0.92, 3.98) | -1.614 | 0.106 |
| MVO mass [g, median (IQR)] | 2.80 (1.62, 5.38) | 1.81 (0.96, 4.18) | -1.560 | 0.119 |
Table 2.
Figure 5
Distribution of AWMI and NAWMI patients in the four groups of different extent of LV enhanced mass. The patients of AWMI and NAWMI were more frequently distributed in the high and low quartiles groups, respectively. The number of patients with AWMI increased with the degree of LV mass enhancement (χ2=8.941, P = 0.03)."
Figure 5
Table 3.
CMR strain characteristics of the LV myocardium in 95 STEMI patients (1,520 segments)"
| Groups | No. of segments | Peak strain [median (IQR)] | Peak systolic strain rate [median (IQR)] | Peak diastolic strain rate [median (IQR)] | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Radial (%) | Circumferential (%) | Longitudinal (%) | Radial (%/s) | Circumferential(%/s) | Longitudinal (%/s) | Radial (%/s) | Circumferential (%/s) | Longitudinal (%/s) | ||||
| Infarct segment | 490 | 12.96 (8.30, 18.95) | -9.97 (-13.26, -6.36) | -9.04 (-14.71, -4.01) | 0.83 (0.47, 1.27) | -0.69 (-0.96, -0.37) | -0.79 (-1.29, 0.62) | -0.88 (-1.33, 0.29) | 0.64 (-0.26, 0.93) | 0.78 (-0.33, 1.16) | ||
| Remote segment | 1,030 | 28.45 (19.57, 38.09) | -17.48 (-21.01, -13.54) | -13.99 (-18.55, -8.95) | 1.72 (1.22, 2.29) | -1.08 (-1.32, -0.85) | -1.13 (-1.54, -0.73) | -1.68 (-2.52, -1.09) | 1.00 (0.75, 1.29) | 0.96 (0.61, 1.36) | ||
| t/Z value | -20.873 | -20.918 | -10.357 | -19.067 | -16.586 | -7.825 | -16.731 | -15.100 | -5.454 | |||
| P value | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||
Table 3.
Table 4.
Global and infarct zone myocardial strains of the AWMI and NAWMI patient group"
| Groups | n | Peak strain [median (IQR)] | Peak systolic strain rate [median (IQR)] | Peak diastolic strain rate [median (IQR)] | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Radial (%) | Circumferential (%) | Longitudinal (%) | Radial (%/s) | Circumferential(%/s) | Longitudinal (%/s) | Radial (%/s) | Circumferential (%/s) | Longitudinal (%/s) | |||||
| Global | AWMI | 44 patients | 18.78 (15.97, 22.32) | -12.80±3.47* | -9.87 (-12.02, -8.20) | 0.98 (0.89,1.30) | -0.72 (-0.83,-0.62) | -0.60 (-0.70, -0.49) | -0.94 (-1.18,-0.64) | 0.65 (0.50,0.75) | 0.53 (0.45, 0.67) | ||
| NAWMI | 51 patients | 22.84 (18.17,26.63) | -14.36±3.14* | -12.50 (-13.45, -10.56) | 1.16 (0.89,1.48) | -0.78 (-0.88,-0.62) | -0.72 (-0.82, -0.61) | -0.98 (-1.40,-0.77) | 0.64 (0.54,0.82) | 0.62 (0.52, 0.76) | |||
| t/Z value | -2.575 | 0.001 | -4.146 | -1.280 | -0.702 | -3.181 | -1.709 | -1.112 | -2.580 | ||||
| P value | 0.010 | 0.025 | <0.001 | 0.200 | 0.483 | 0.001 | 0.087 | 0.266 | 0.010 | ||||
| Infarct zone | AWMI | 258 segments | 12.49 (7.32,18.03) | -9.54 (-12.70,-5.72) | -6.95 (-12.10,3.22) | 0.81 (0.34,1.21) | -0.67 (-0.98,0.27) | -0.62 (-1.13,0.63) | -0.81 (-1.26,0.58) | 0.64 (-0.50,0.91) | 0.63 (-0.51,0.97) | ||
| NAWMI | 232 segments | 13.82 (8.77,20.63) | -10.24 (-14.00, -7.17) | -11.68 (-16.10, -6.54) | 0.89 (0.53,1.30) | -0.71 (-0.93,-0.43) | -0.98 (-1.44,0.53) | -0.93 (-1.47,-0.47) | 0.64 (0.38,0.97) | 0.95 (0.51,1.31) | |||
| t/Z value | -2.139 | -2.086 | -6.785 | -1.909 | -1.038 | -3.634 | -2.606 | -1.824 | -4.950 | ||||
| P value | 0.032 | 0.037 | <0.001 | 0.056 | 0.299 | <0.001 | 0.009 | 0.068 | <0.001 | ||||
Table 4.
Figure 6.
Correlations between the volume and infarct characteristics of the LV with infarct zone strain. Correlation of peak systolic radial strain rate with ESVI (A) and total enhanced mass (B) in the AWMI group; Correlation of peak systolic radial strain rate with myocardial mass in the NAWMI group (C)."
Figure 6.
Figure 7.
Kaplan-Meier plot assessing event-free survival in the AWMI and NAWMI groups. The inter-observer variability of peak strain A total of 15 randomly selected patients underwent an interobserver variability analysis conducted by two independent observers. The variability assessments of peak global and infarct zone strains were shown in Table 5. Good inter-observer agreement of peak global strains (ICC 0.829, 0.859, and 0.780, respectively) and peak infarct zone strains (ICC 0.876, 0.870, and 0.899, respectively) were found."
Figure 7.
Table 5.
The inter-observer variability of peak strain"
| Items | ICC | 95%CI |
|---|---|---|
| Global | ||
| Radial | 0.829 | 0.560-0.939 |
| Circumferential | 0.859 | 0.629-0.951 |
| Longitudinal | 0.780 | 0.475-0.920 |
| Infarct zone | ||
| Radial | 0.876 | 0.678-0.956 |
| Circumferential | 0.870 | 0.666-0.954 |
| Longitudinal | 0.899 | 0.728-0.965 |
Table 5.
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